PROGRESS TOWARDS POLIO ERADICATION, 2011-2012

Monday, 21st of May 2012

POLIO ERADICATION, 2011-2012

From thw Weekly Epidemiological Record, http://www.who.int/wer/2012/wer8720.pdf

Editorial note

The most significant achievement of the GPEI during January 2011–March 2012 was the interruption of endemic WPV circulation in India, considered polio-free as of February 2012. Success in India is attributed to innovative approaches by the Indian government and partners, including the large-scale mobilization of human and financial resources to increase SIA coverage in children in high-risk endemic areas and migrant populations, introduction of bOPV, improvements in routine immunization coverage, and rapid responses to new outbreaks.8

India’s success proves the technical viability of global polio eradication and offers tested

solutions to many operational challenges in other countries Also, an unprecedented reduction in WPV3 cases globally has occurred since January 2011. Khyber agency in Pakistan and several northern states in Nigeria are the only areas from where WPV3 cases continue to be reported.9, 10

Outbreaks following importations into polio-free countries pose a continued threat to the momentum of the GPEI. Large outbreaks occurred in 2010 in the European Region11 and in the Republic of the Congo;12 outbreaks in 2011 have been small because of timely detection and prompt response SIAs. The outbreak in China in 2011 was rapidly contained through massive response SIAs, which in some areas included vaccination of all persons up to 40 years of age. Older age groups have been affected by polio with high case fatality rates in a number of recent outbreaks. Even when not affected, older children and adults appear to enhance WPV transmission. To reduce the scope and duration of any new outbreaks in polio-free areas, GPEI is recommend-ing that strong consideration be given to vaccination of all children aged <15 years in the initial response SIAs.

Until WPV transmission in all areas is interrupted, the threat of outbreaks in polio-free areas will continue, requiring all countries to maintain high routine immunization coverage, sensitive AFP surveillance, and rapid detection of outbreaks, with prompt immunization response. Continued intense WPV transmission in northern Nigeria poses a significant threat of WPV importation and spread into other west and central African countries.

In response to the WHO Executive Board’s recognition of poliovirus eradication as a programmatic emergency for global public health1, each of the remaining countries with endemic or re-established transmission has developed an emergency action plan for interrupting wild poliovirus transmission, which includes oversight and accountability mechanisms and engaging political and health leaders at all administrative levels. National emergency plans specify strategies to vaccinate chronically missed children, improve the quality of SIAs in persistently poor performing areas and achieve levels of immunity be end 2012 that can lead to cessation of transmission. These strategies also address inadequate

micro-planning, poor selection and performance of vaccination teams, weak supervision, inadequate monitoring and refusal to accept vaccine. Special strategies were developed to access children in areas of armed conflict and insecurity. National emergency plans also outline strategies to identify, map and vaccinate children in migrant and mobile populations and to improve routine immunization services, particularly for high-risk population groups.

Informed by national emergency plans and in recognition of global challenges, the GPEI has developed a Global Emergency Action Plan (GEAP) 2012–2013. Key objectives of the plan are (i) to assist Afghanistan, Nigeria and Pakistan to significantly increase immunization coverage by the end of 2012 to levels that will interrupt transmission shortly thereafter, (ii) to help to sustain the momentum achieved in Chad, DRC and Angola to interrupt transmission in 2012, (iii) to further improve polio partner accountability and coordination and (iv) to close the large global funding gap. Funding requirements for the GEAP 2012–2013 are US$ 2.18 billion. The GPEI continues to face a grave shortfall of just under billion to finance the programme for 2012–2013. Lack of funds has already forced the cancellation and scaling-back of SIAs in 24 countries in the first part of 2012. A continued funding crisis will preclude the full implementation of national emergency plans and jeopardize the goal of a polio-free world.